Transcript 2-Thyroid Hormones.ppt

Biochemistry of Thyroid Hormones
and Thermogenesis
Endocrine Block
1 Lecture
Dr. Usman Ghani
Overview
 Types and biosynthesis of thyroid hormones
 Thyroid hormone action
 Regulation of thyroid hormones
 Thyroid function tests
 Goitre
 Hypo and hyperthyroidism
 Causes
 Diagnosis
 Treatment
 Thermogenesis
Types and biosynthesis of
thyroid hormones
 Thyroxine (T4) and tri-iodothyronine (T3)
 Synthesized in the thyroid gland by:
 Iodination
 Coupling of two tyrosine molecules
 Attaching to thyroglobulin protein
 Thyroid gland mostly secretes T4
 Peripheral tissues (liver, kidney, etc.) deiodinate T4 to
T3
Types and biosynthesis of
thyroid hormones
 T3 is more biologically active form
 T4 can be converted to rT3 (reverse T3) – inactive form
 Most of T4 is transported in plasma as protein-bound
 Thyroglobulin-bound (70%)
 Albumin-bound (25%)
 Transthyretin-bound (5%)
 The unbound (free) form of T4 and T3 are biologically
active
Plasma level: 100 nmol/L
Plasma level:
2 nmol/L
Thyroid hormone action
 Essential for normal maturation and metabolism of all
body tissues
 Affects the rate of protein, carbohydrate and lipid
metabolism
 Regulates thermogenesis
Thyroid hormone action
 Hypothyroid children have delayed skeletal
maturation, short stature, delayed puberty
 Untreated congenital hypothyroidism causes
permanent brain damage
 Hypothyroid patients have high serum cholesterol due
to:
 Down regulation of LDL receptors on liver cells
 Failure of sterol excretion via the gut
Regulation of thyroid hormone secretion
 The hypothalamic-pituitary-thyroid axis regulates
thyroid secretion
 The hypothalamus senses low levels of T3/T4 and
releases thyrotropin releasing hormone (TRH)
 TRH stimulates the pituitary to produce thyroid
stimulating hormone (TSH)
Regulation of thyroid hormone secretion
 TSH stimulates the thyroid to produce T3/T4 until
levels return to normal
 T3/T4 exert negative feedback control on the
hypothalamus and pituitary
 Controlling the release of both TRH and TSH
High thyroid levels
suppress TRH
and TSH
Low thyroid levels
stimulate TRH
and TSH to produce
more hormone
Thyroid function tests
 TSH measurement:
 Indicates thyroid status
 Total T4 or free T4:
 Indicates thyroid status
 Monitors anti-thyroid treatment
 Monitors thyroid supplement treatment
 TSH may take upto 8 weeks to adjust to new level
during treatment
 TSH and T4 (total or free) are sensitive, first-line test
 Some labs only measure TSH as first-line test
Thyroid function tests
 Total T3 or free T3:
 Rise in T3 is independent of T4
 In some patients only T3 rises (T4 is normal)
 For earlier identification of T3 thyrotoxicosis
 Antibodies:
 Diagnosis and monitoring of autoimmune thyroid
disease (Hashimoto’s thyroiditis)
Goitre
 Enlarged thyroid gland
 May be associated with:
 Hypofunction
 Hyperfunction
 Normal function of thyroid gland
 Causes:
 Iodine deficiency
 Selenium deficiency
 Hashimoto’s thyroiditis
 Congenital hypothyroidism
 Graves' disease (hyperthyroidism)
 Thyroid cancer
Hypothyroidism
Deficiency of thyroid hormones
 Primary hypothyroidism:
 Failure of thyroid gland
 Secondary hypothyroidism:
 Failure of the pituitary to secrete TSH (rare)
 Failure of the hypothalamic-pituitary-thyroid axis
Hypothyroidism
 Causes:
 Hashimoto’s disease
 Radioiodine or surgical treatment of hyperthyroidism
 Drug effects
 TSH deficiency
 Congenital defects
 Severe iodine deficiency
 Clinical features
 Tiredness
 Cold intolerance
 Weight gain
 Dry skin
Hypothyroidism
 Diagnosis
 Elevated TSH level confirms hypothyroidism
 Treatment
 T4 replacement therapy (tablets)
 Monitoring TSH level to determine dosage
 Patient has to continue treatment for life
 Neonatal hypothyroidism
 Due to genetic defect in thyroid gland of newborns
 Diagnosed by TSH screening
 Hormone replacement therapy
 May cause cretinism, if untreated
Hypothyroidism
 Non-thyroidal illness
 In some diseases, the normal regulation of TSH, T3 and
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T4 secretion and metabolism is disturbed
Most of T4 is converted to rT3 (inactive)
Causing thyroid hormone deficiency
TSH secretion is suppressed
Secretion of T4 and T3 is decreased
Hyperthyroidism
 Over-activity of the thyroid gland
 Increased secretion of thyroid hormones
 Tissues are exposed to high levels of thyroid hormones
(thyrotoxicosis)
 Increased pituitary stimulation of the thyroid gland
 Causes:
 Graves' disease
 Toxic multinodular goitre
 Thyroid adenoma
 Thyroiditis
 Intake of iodine / iodine drugs
 Excessive intake of T4 and T3
Hyperthyroidism
Clinical features
 Weight loss with normal appetite
 Sweating / heat intolerance
 Fatigue
 Palpitation / agitation, tremor
 Angina, heart failure
 Diarrhea
 Eyelid retraction and lid lag
Graves' disease
 Most common cause of hyperthyroidism
 An autoimmune disease
 Antibodies against TSH receptors on thyroid cells
mimic the action of pituitary hormone
 Normal regulation of synthesis/control is disturbed
Hyperthyroidism
Diagnosis
 Suppressed TSH level
 Raised thyroid hormone level
 Confirms primary hyperthyroidism
Problems in diagnosis
 Total serum T4 conc. changes due to changes in
binding protein levels
 In pregnancy, high estrogens increase TBG synthesis
 Total T4 will be high
Hyperthyroidism
 Congenital TBG deficiency can also influence results
 Free T4 and TSH are first-line tests for thyroid
dysfunction
Treatment
 Antithyroid drugs: carbimazole, propylthiouracil
 Radioiodine: sodium 131I inhibits T4/T3 synthesis
 Surgery: thyroidectomy
Thermogenesis
 Thyroid hormone has an active role in thermogenesis
 About 30% thermogenesis depends on thyroid
 Thyroid regulates metabolism and ATP turnover
 It increases ATP synthesis and consumption by many
possible mechanisms
Thermogenesis
 Na/K gradient requires ATP to maintain it
 The gradient is used to transport nutrients inside the
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cell
Thyroid reduces Na/K gradient across the cell
membrane
Causing more nutrient transport in the cell (increasing
metabolism)
This increases the demand for ATP to maintain the
gradient
ATP synthesis and consumption is increased that
produce heat
Thermogenesis
 Thyroid hormones cause increased proton leak into
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the matrix across the inner mitochondrial membrane
Protons are pumped back into the matrix by
uncoupling proteins (UCPs) without ATP synthesis
This process produces heat
The mitochondria of brown adipose tissue contain
UCP-1 (thermogenin)
Produces heat via uncoupling of electron transport
chain and oxidative phosphorylation